This adage elicited chuckles and head nods from the knowing audience of the Mobile Integrated Healthcare Summit held this February in San Diego as part of the Firehouse World expo. As more fire and EMS agencies begin to retool their care models, they’re finding that as they step outside their traditional roles, forming partnerships becomes more important than ever.

At Mesa Fire and Medical Department in Mesa, Ariz., Chief Harry Beck and medical director Gary Smith emphasize the value of their partner organizations. From the local hospital and primary care providers to city councilmembers and private-sector businesses, forming partnerships outside the fire department was a key takeaway of the Mesa model.

“You cannot function in silos,” Smith told the audience.

Medical partners

Mesa’s model utilizes two transitional response vehicles, staffed with one paramedic and one firefighter, and a community care response unit staffed with one paramedic and either a nurse practitioner or a behavioral health specialist. These units are active during peak times to handle low acuity calls. They treat patients, refer them to primary care or other appropriate destination, write certain prescriptions and follow up with patients to make sure they’re taking the recommended steps.

Mesa’s partner hospital IASIS Healthcare provides a nurse practitioner at their cost to staff the community care unit—a move they are incentivized to do because it helps keep patients from being readmitted to the emergency room for their conditions.

The hospital isn’t the only medical agency involved. Through an Innovation Grant from the Centers for Medicare and Medicaid Services (CMS), Smith said the department has been gradually working toward a model in which EMS operates in conjunction with all levels of medical providers: Community paramedics treat low acuity 9-1-1 callers on the scene instead of transporting to the ED, and primary care providers and specialists can refer back out to EMS to follow up on patients post-discharge to make sure they’re complying with doctor recommendations, taking prescriptions as directed and not putting themselves on a path to be readmitted to the hospital.

Smith reiterated that the fire department is not trying to replace primary care, but that they are two members of the same team working toward a common goal. He said the biggest pushback has come from ED physicians who still work under a fee-for-service model, and that diplomacy and forming partnerships are the best tools for addressing these conflicts.

Community buy-in

Mesa credits much of its success to the partnerships formed outside of medical care providers. Local politicians, private enterprise, employees, labor unions, schools and the community members who will be most affected are important sources of support.

A good public information officer (PIO) can help a department substantially in this aim—Smith shared video from local news footage that helped spread the message of what the department was aiming to accomplish and the benefits to citizens. Mesa’s PIO proactively contacted local news teams and hosted ride-alongs to better convey the department’s plan for achieving higher standards of community healthcare.

Data was a key factor in attaining community buy-in. “You need to be data-driven,” Beck told the audience in San Diego. “Ask basic questions and you’ll get great information.”

That information is important to have on hand when bargaining for taxpayer dollars. Beck recommended consistent reporting to the city manager or other government representatives to remind them of the value provided. He specifically cited runaway 9-1-1 call volumes as a motivating factor for the city to support system changes.

Data collection is integral to another key process: self-evaluation. As the Affordable Care Act continues to take root and the concept of utilizing EMS to keep patients out of the ED becomes the accepted way of doing business, competition in this space is only going to increase. Agencies will need to evaluate their own performance objectively and strive to deliver a truly valuable service if they are to achieve financial stability. And that financial stability is how agencies can tie in support from their own labor force.

Fire departments will be especially prone to cries of “that’s not our job” when proposing system changes to make house calls and check in on patients. Smith said that when he looked at the data, he found that nearly 80% of fire calls in Mesa were for medical cases. One of the earliest changes made was the department’s name, from Mesa Fire Department to Mesa Fire and Medical, to better reflect the reality of work that they do. This allowed them to address inefficiencies that had been built into the old system and convince the firefighters that yes, providing medical care is their job.

Mesa began offering advanced training and certification opportunities to its firefighters to further their careers and make them more valuable to the agency. All educational programs were tied to contracts such that firefighters are obligated to stay with the department for a certain period of time after completion. Investment in people and in the community is an important factor for success in this new model for EMS.

Start small

Both Smith and Beck were quick to recognize that what works in Mesa won’t necessarily work for all departments and financial constraints will be the greatest challenge across the board. “Go for the low-hanging fruit,” Beck said. “You don’t have to have a mobile vehicle.”

One possible example he mentioned was hosting periodic clinics in the fire department for community members to refill basic prescriptions, get flu shots and get basic medical assessments. This can open the door for discussions with accountable care organizations (ACOs), other area EMS providers, local government and other community players.

Another low-hanging fruit: Helping the uninsured sign up for medical coverage on healthcare.gov. Nonpayers remain around 20% of healthcare patients, but it only takes a community paramedic with a little bit of training and an iPad to help people sign up for the insurance coverage that they need.

A key takeaway for other agencies looking to implement the same model is to evaluate the specific needs of their individual communities. For example, the city of Mesa experiences a large influx of mostly elderly visitors each winter, so the fire and medical department adjusted its deployment model to account for this. They identified a need to conduct in-home safety inspections to help decrease the number of falls in elderly patients. Data showed that nearly 40% of those patients who fell in their home and dialed 9-1-1 were hospitalized, so preventing those falls became a priority for both the department and partner hospitals.

In describing the department’s gradual goals and step-by-step approach, Beck offered another adage: “You have to eat the elephant one bite at a time.”

Kristina Ackermann is the managing editor of EMS Insider . Reach her at .